Saudi Journal of Gastroenterology
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   1999| May-August  | Volume 5 | Issue 2  
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Pattern of gastrointestinal diseases in adult patients admitted to Samtah General Hospital, Gizan region, Saudi Arabia
Emmanuel Aderemi Aderoju, Dan Ene, Hamood Abutalib, Ignatius Aboh, Thomas Nnanyelu Okonkwo
May-August 1999, 5(2):76-80
To determine the relative frequencies of gastrointestinal diseases (GI) in patients admitted to Samtah General Hospital, Gizan, the records of 2,442 adults admitted to the medical and surgical services for gastrointestinal diseases during the period 1413 to 1416 were analyzed retrospectively. 1,028 patients had acute appendicitis. The remaining 1,414 patients were admitted for various other GI diseases. In these 1,414 patients the commonest diseases were gastrointestinal infections (36.4%), peptic ulcer disease (19%), gall bladder disease (18.5%), viral hepatitis and its sequelae (20.7%). Despite the high prevalence of cholelithiasis, acute pancreatitis was uncommon (0.1 %). Inflammatory bowel disease was rare. There was no gender - related difference in the prevalence of gastrointestinal infections, peptic ulcer disease and carcinoma of the stomach. Males were significantly more afflicted than females with viral hepatitis (p<0.0001), cirrhosis of the liver (p<0.0001), hepatocellular carcinoma (p<0.0005), variceal bleeding (p<0.0005), and peptic ulcer bleeding (p<0.005). As a large proportion of our patients had preventable diseases, it is expected that immunization and other public health measures will reduce the frequency of these diseases in the future.
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Comparison of H. pylori-gastritis among young and old patients by using "the modified Sydney system of classification and grading"
Abdur Rauf Khan
May-August 1999, 5(2):81-84
It is well known that the age at which H. pylori infection is acquired is crucial in the genesis of gastric cancer () . The aim of the study is to compare antral biopsies from younger (age range 3 - 20 years) and older (age range 51 - 60 years) patients infected with H. pylori. The biopsies were graded for five parameters according to the guidelines from "The modified Sydney System of Classification and Grading of gastritis" (2). There was no significant difference in three parameters i.e. H. pylori density, neutrophilic activity and chronic inflammation between the two age groups. Two parameters i.e. the mucosal atrophy and intestinal metaplasia were, however, more prevalent in older age group. They are considered preneoplastic for gastric cancer. This study demonstrated that the intensity of inflammation is not age related. Preneoplastic changes do, however, begin to emerge later in life.
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Childhood obesity: Referred cases to a tertiary health center in Riyadh, Saudi Arabia
Abdullah S Al Herbish, Nasir Al Jurayyan, Abiodun Olasope, Asaad M.A Abdullah, Abdulrahman A Al Nuaim
May-August 1999, 5(2):85-88
Objective: To show the pattern of etiology of childhood obesity referred to our endocrinology clinic between December 1989 and December 1994. Subject and Methods: All the children referred to our clinic at the above stipulated dates were studied. This is a retrospective medical records review of these patients. The patients' height and weight were measured by trained staff of the clinic. The Quetelet index also known as Body Mass Index (BMI) was calculated as weight (kg)/height (m)2 for each patient. Laboratory data as well as results of clinical investigations were also obtained from the records of the patients. Results: 52 patients with ages ranging between 2 years and 16 years (median 8 years) were studied. Male : female ratio was 1:1. 35 (67.3%) of the patients were Saudis while 17 (32.7%) were non-Saudis. The etiology of obesity among the series were nutritional 46 (88.5%), Prader-Willi Syndrome 3 (5.8%), Laurence-Moon-Biedl Syndrome 1 (1.9%), pseudohypoparathyroidism 1 (1.9%) and hypothyroidism 1 (1.9%). The study showed that the majority of the patients had simple nutritional obesity.
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Laparoscopic cholecystectomy is feasible and safe in acute cholecystitis
Abdulmohsen Abdullah Al-Mulhim
May-August 1999, 5(2):56-60
Objective: To assess the feasibility and safety of laparoscopic cholecystectomy in acute cholecystitis. Subjects and Methods: Between June 1993 and December 1996, 424 consecutive patients underwent laparoscopic cholecystectomy; 45 (10.6%) had acute cholecystitis confirmed by ultrasound. Results: All 45 patients were opened within 72 hours of admission. Conversion to open cholecystectomy was necessary in three patients (6.7%). The mean operating time was 126 minutes (range: 40-300 minutes). There was no mortality or common bile duct injury in this series. The postoperative stay averaged 3.9 days (range: I to 11 days). There was no delayed morbidity after a mean follow-up of 2 years. Conclusion: Laparoscopic cholecystectomy is feasible and safe in patients with acute cholecystitis, provided it is performed by experienced surgeons. Although the procedure is somewhat lengthy, it is associated with low conversion rate, no serious morbidity and zero mortality.
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Esophageal candidiasis among a dyspeptic population
Ibrahim Abdulkarim Al Mofleh, Mohammad Abdullah Al Mofarreh
May-August 1999, 5(2):61-65
This is a retrospective study of 59 patients endoscoped over a period of six years at a private clinic and were found to have esophageal candidiasis. The median age was 46.38 years. Thirty (51 %) patients had no precipitating factors. Only 18 (30%) patients had typical symptoms. The distal part of the esophagus was more often involved. The thrush was scattered in 57 (97%) patients. The endoscopic finding was confirmed by cytology in all patients included. Symptoms improved on oral nystatin treatment and simultaneous treatment of associated conditions in all 46 patients followed up. In conclusion, esophageal candidiasis appear to be not uncommon among dyspeptic population. It presents more frequently with atypical symptoms and responds well to oral nystatin treatment.
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Frequency of endoscopic esophagitis in nutcracker patients with pathological 24-hour pH monitoring
Saleh Mohsen Al Amri
May-August 1999, 5(2):66-70
Endoscopically, it was claimed that reflux esophagitis is less frequently seen in patients with tertiary contractions. The aim of this prospective study is to evaluate the frequency of endoscopic esophagitis in nutcracker patients with pathological 24-hour pH monitoring as compared to a matched group of patients with pathological prolonged ambulatory pH monitoring. The study included eight patients with nutcracker esophagus and pathological 24-hour pH monitoring (Group 1); mean (SD) age was 36.5 (10.6) years, mean (SD) LES pressure was 11 (2.9) mmhg and % total pH <4 was 11.5 (7), which were not statistically different from a matched control of 25 patients (Group 2). Patients with underlying definable systemic diseases were excluded from the study.. Three nutcracker esophagus and eight control showed evidence of endoscopic esophagitis (P value=0.9). Among group I, nutcracker patients with endoscopic esophagitis had a tendency towards a lower LES pressure (P=0.056) and a significantly greater % total pH <4 (P=0.04). % upright reflux (P=0.03) and total time pH <4 (P=0.003) than nutcracker without endoscopic oesophagitis. Moreover, nutcracker patients with endoscopic esophagitis had a significantly greater % total pH <4 and total time pH <4 than control group with endoscopic esophagitis with P value = 0.03 and 0.02, respectively. Conclusion: The frequency of endoscopic esophagitis is similar in nutcracker and a matched control with pathological 24-hour pH monitoring.
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Radionuclide esophageal transit time for the assessment of pneumatic dilation in patients with achalasia
Mahmoud El-Desouki, Saleh Othman, Rashed Al-Rashed, Mohd Mohamadiyeh, Saleh Al-Amri, Ibrahim Al-Mofleh
May-August 1999, 5(2):71-75
Objective: The aim of this study was to assess the value of radionuclide esophageal transit time (RET) in prediction of the results of pneumatic dilation in patients with achalasia. Patients and methods: Thirty patients (13 males) with a mean age of 37 ± 15.6 years (range 17-73 years) were included in the study. All patients were diagnosed to have idiopathic achalasia of the cardia and selected for pneumatic dilation. Each patient had three RET, two the same day of dilation (pre­and postdilation) and a third follow up one within three months of dilation (4 patients failed to come for follow up and were excluded). Results: Several parameters were derived from RET studies, T/50: time required for 50% of activity in the esophagus to be cleared, T/10 : time required for 90% of activity in the esophagus to be cleared and percentage clearance at 10 min. These parameters were compared to response of dysphagia to dilation. It was evident that the higher the esophageal clearance postdilation, the better the outcome. When immediate post dilation clearance was 85% or more the success rate was 83.3% whereas when it was 20-50% the success rate was only 21.4%. No relation was found between T/50, T/10 and dysphagia response. Conclusion: RET appears to be a useful quantitative procedure in the assessment of pneumatic dilation outcome in achalasia patients.
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Primary peritonitis revisited
Oluwole Gbolagunte Ajao, Mohammed Y Al Shehri, Mohammed Al Naami, Said Ali Saif, Abdulla S Refeidi, Ali Manea Al Ahmary, MA Al Jarallah, Ali Hassan Assiri, Ahmad M.S Al Faki
May-August 1999, 5(2):89-91
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Writing a clinical research paper
Oluwole Gbolagunte Ajao
May-August 1999, 5(2):45-49
A well-known unwritten law in institutions of higher learning is that of "Publish or perish". The duties of a University teacher, in order of priority are teaching, research and service. Reasons for writing clinical research papers are to get promoted, to get research grants and to make known, one's findings in order to improve patients' care. Writing papers is also a means of delivering continuous education, therefore publication is essential for any one pursuing an academic career. Research papers can be in the form of case reports, retrospective studies, prospective studies and laboratory or animal research. Two popular formats of writing papers are: The Vancouver Style and the Harvard System.
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Hepatitis G virus (HGV) and liver diseases
Sami Ramia, Faleh Zaid Al Faleh
May-August 1999, 5(2):50-55
Recently, a new flavi-like virus, provisionally named hepatitis GBV-C or hepatitis G virus (HGV), has been described and was initially thought to be the major etiological agent of non-A-E hepatitis. HGV does not induce an immune response that is consistently detectable by using recombinant proteins from prokaryotic expression and hence prevalence studies have been conducted by using polymerase chain reaction (PCR)-based system. HGV-RNA has been detected in many human populations. This article reviews what has been investigated about HGV from normal blood donors, patients with liver disease, patients at risk of acquiring the infection to possible perinatal and sexual transmission of the virus. Based on the conclusions that can be drawn from these studies conducted so far, the association between HGV infection and liver disease is still not certain. It is possible that HGV might play a role in other diseases not involving the liver, but at the present time HGV can be considered as an orphan flavivirus still looking for a human disease.
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